Ist die Hormontherapie bei Hodenhochstand noch zeitgemäß?

Zusammenfassung

Die Hormontherapie wurde über Jahrzehnte (zumindest in Europa) als integraler Bestandteil der Behandlung des Hodenhochstandes angesehen. Die Datenlage ist jedoch ausgesprochen kontrovers. Die Induktion des Deszensus gelang in vielen Studien und laut einer großen Metaanalyse nur in ca. 20 % der Fälle, einzelne kleinere Studien beschreiben bessere Ergebnisse. Auch die potenzielle Verbesserung der Fertilität wird in einigen Studien als erwiesen angegeben, andere beschreiben gegenteilige Ergebnisse.

Inzwischen wurde die Hormontherapie aus den meisten internationalen Leitlinien vollends entfernt und wird auch in Deutschland nur noch für wenige Indikationen empfohlen. Bez. der Induktion des Deszensus hat die Hormontherapie aufgrund der vielfach dokumentierten unzureichenden Wirksamkeit keinen hohen Stellenwert mehr, lediglich mit dem Ziel der potenziellen Fertilitätsverbesserung bei bilateralem Hodenhochstand wird sie noch mit einer gewissen Zurückhaltung empfohlen.

In Anbetracht der widersprüchlichen Datenlage fällt es schwer, die Hormontherapie aktuell noch zu empfehlen.

Abstract

For decades, hormonal therapy was considered an integral part of the treatment regimen for undescended testes, particularly in Europe. However, the available data are controversial. According to many studies and a large meta-analysis, testicular descent can only be achieved in approximately 20 % of cases, whereas a few small studies report better results. Improvement of fertility is also considered significant in some studies, while others even report detrimental effects. Meanwhile, the recommendations for the use of hormonal therapy have been removed from most international guidelines. In Germany, hormonal therapy is only recommended for a limited number of indications. It is widely accepted that hormonal therapy has no particular value in the induction of testicular descent, and even the possible improvement of fertility in cases of bilateral undescended testes is regarded with some caution. In light of the controversial and weak data, it is questionable if hormonal therapy should still be recommended.

Schlüsselwörter

Maldescensus testis - Hodenhochstand - Hormontherapie - Deszensus - Fertilität

Keywords

descent - fertility - cryptorchidism - hormonal therapy - undescended testis

Publication History

Article published online:
24 March 2020

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